Formerly a discipline devoted to research on sanitation and epidemiology, public health is now more or less an explicitly ideological field devoted to ginning up panic over freely chosen, private behaviors and to cheerleading for paternalist government action to prohibit or discourage them. Take any fun activity enjoyed by those who are not urbanized, (generally) white, middle-aged, highly educated professionals – smoking, shooting, drinking, eating tasty food, calling a friend in the car, generally exercising “personal freedoms” – “public health advocates” are agin’ it. (Of course, you don’t see them agitating against marathon running or rock climbing or bungee-jumping or long-distance hiking or extramarital sex. Fun, risky things that urbanized, highly educated professionals like.)Jason Sorens at Pileus nails it. I'll be guest blogging over at Pileus later this month; it looks like I'll be in very good company.
The politics behind today’s public-healthery are sinister. They are driven by loathing of the poor, the overweight, people who shop at Wal-Mart and eat at fast-food joints, people with a Southern accent (who probably own guns and might even smoke) – the list goes on. Otherwise, why aren’t progressive-dominated governments trying to ban colorful local diners and casual-dining chains the way they are fast-food chains – even though the former often have higher-calorie food and don’t even report calorie counts to their customers? Of course, it’s the white middle classes who frequent quaint diners and TGI Friday’s.
So – I raise a glass of whisky and a cigar to the hope of a backlash against “public health,” a new Coalition for Fun.
I've a piece in today's New Zealand Medical Journal taking another swipe at the healthists. The page proofs are at the end of the post for folks without a subscription.
Let’s begin with CHB’s [Peter Crampton, Hoek and Beaglehole] case against efficient markets. They argue that because models of perfect markets require a set of conditions not found in the real world, extensive and comprehensive government intervention in individual health choices is necessary. You could just as reasonably argue that because Earth has an atmosphere, we needn’t worry about falling off of cliffs: theories of gravitational acceleration of 9.8 metres per second squared are derived for a vacuum and so do not here apply.I get really irritated at the claim that, if we have any kind of market failure, we can throw standard economics out the window. The claim's made a lot in the alcohol social cost literature - from the early Single et al papers through to Collins and Lapsley. If we take a straight neoclassical line, the failure tells us the type of interventions that might be warranted. If you still don't like the outcome after the correction's been made, that's too bad. If we take a more Austrian line, it's the presence of these failures that opens up market opportunities for entrepreneurs to come in and transform deadweight losses into profits.
The conditions under which markets can be shown to maximise efficiency—the benchmark case against which market failure is measured—are sufficient rather than necessary. We can be at an optimum even if the conditions fail.3 Under those idealised conditions, it is impossible to make any person better off without simultaneously making someone else worse off.
Where the idealised conditions fail, we have some guidance about policies that may improve outcomes, but do not necessarily do so. The market failure is necessary but not sufficient for policy to meliorate outcomes. Proving a particular failure does not give us carte blanche to implement any intervention we like; rather, it tells us where an intervention might be targeted. And it also tells us when intervention isn’t warranted.
As case in point, consider the potential for market failure caused by imperfect information about calorie counts. If consumers are mistaken about true calorie counts, they might eat more or less than they would under conditions of full information. Perhaps. Let’s leave aside for the moment the ease with which any consumer could investigate calorie counts at most fast food restaurants simply by checking their websites— if he actually cared. But experiments making calorie counts really salient at point of fast food purchase show no effect on purchases.4
The rather mixed evidence on the effects of information provision suggests to me that there was no real information market failure. If your reaction to the evidence is “well, let’s try a different intervention then and claim a different market failure as justification”, you’re no longer making the case based on market failure; you’re just being paternalistic. Public health activists have been abusing market failure theory to give a sciency flavour to what is actually just paternalism.5
I don't know whether the "any failure justifies any intervention" line comes from a deliberately opportunistic reading of principles-level texts or if we've screwed up as a profession in teaching principles of micro.
Cursed Rhetoric Page Proofs